MANAGEMENT OF THIRD STAGE OF LABOUR;

USE OF INTRAMUSCULAR SYNTOMETRINE AND INTRAVENOUS OXYTOCIN

Abstract

The routine prophylactic administration of an uterotonic agent is an integral
part of active management of the third stage of labor, helping to prevent postpartum haemorrhage (PPH). The two most
widely used uterotonic agents are: ergometrine-oxytocin (Syntometrine ®) (a combination of oxytocin, 5 international
units (iu) and ergometrine, 0.5 mg) and oxytocin, (Syntocinon ®) 10 international units (iu). Objective: To compare the
efficacy and safety of intravenous oxytocin, with intramuscularly syntometrine in the management of third stage of labor.
Study design: Experimental study. Setting: Department of obstetrics and gynaecology Combined Military Hospital
Peshawar. Period: Over one year period from March 2005 to March 2006. Methods: A total 200 women having
singleton pregnancy and vaginal delivery admitted in maternity ward were divided in two treatment groups by simple
random sampling using random number tables, 100 patients received 2 ml Syntometrine, (a combination of oxytocin,
5iu and ergometrine meleate 0.5mg) intramuscularly and 100 patients received 10iu of intravenous syntocinon at the
delivery of anterior shoulder of the fetus. Results: The use of intravenous oxytocin,, was associated with a reduction
in postpartum blood loss (P<0.001) but there was no difference in the risk of post partum hemorrhage, in the need for
repeated oxytocin injections and the drop in peripartum hemoglobin level between the two groups, and need for blood
transfusion. There was also no difference in the risk of prolonged third stage, or manual removal placenta. The use
of syntometrine was associated with a higher risk of hypertension (RR 2.39, 95% Cl 1.00-5.70) other side effects were
mild in nature with no differences between the two groups. Conclusions: There are no important clinical differences
in the effectiveness of intramuscular syntometrine and. Intravenous oxytocin for the prevention of post partum blood
loss. Intravenous oxytocin is less likely to cause hypertension and other side effect profiles are low